Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania.
Neurourol Urodyn. 2019 Jun;38(5):1241-1249. doi: 10.1002/nau.23994. Epub 2019 Apr 4.
To validate the functionality of an implantable pudendal nerve stimulator under development for Food and Drug Administration approval to restore bladder function after spinal cord injury.
In nine cats under anesthesia, two tripolar cuff electrodes were implanted bilaterally on the pudendal nerves and one bipolar cuff electrode was implanted on the right pudendal nerve central to the tripolar cuff electrode. The pudendal nerve stimulator was implanted subcutaneously on the left lower back along the lumbosacral spine and connected to the cuff electrodes. In five cats, a double lumen catheter was inserted into the bladder through the urethra to infuse saline and measure bladder pressure and another catheter was inserted into the distal urethra to perfuse and measure the back pressure caused by urethral contraction. In four cats, a bladder catheter was inserted into the bladder dome and the urethra was left open so that voiding could occur without urethral outlet obstruction.
The implantable pudendal nerve stimulator was controlled wirelessly and successfully provided the required stimulation waveforms to different cuff electrodes. Pudendal nerve stimulation (PNS) at 5 Hz increased bladder capacity to about 200% of control capacity. PNS at 20 to 30 Hz induced large (80-100 cmH O) bladder contractions under isovolumetric conditions. When combined with ipsilateral or bilateral pudendal nerve block induced by 6 to 10 kHz stimulation, PNS at 20 to 30 Hz elicited low pressure (<40 cmH O) efficient (70%) voiding.
The implantable stimulator generated the required stimulation waveforms and successfully induced low pressure efficient voiding in anesthetized cats.
验证一种植入式阴部神经刺激器的功能，该刺激器正在开发中，将获得美国食品和药物管理局批准，用于恢复脊髓损伤后的膀胱功能。
在 9 只麻醉猫中，双侧阴部神经植入两个三极袖套电极，一个双极袖套电极植入三极袖套电极中央的右侧阴部神经。阴部神经刺激器沿腰骶脊柱植入左腰背部皮下，并与袖套电极相连。在 5 只猫中，通过尿道将双腔导管插入膀胱以输注生理盐水并测量膀胱压，另一个导管插入远端尿道以灌注并测量尿道收缩引起的背压。在 4 只猫中，将膀胱导管插入膀胱穹窿，尿道保持开放，以便在没有尿道出口梗阻的情况下排尿。
可植入的阴部神经刺激器通过无线控制成功地为不同的袖套电极提供了所需的刺激波形。5Hz 的阴部神经刺激（PNS）将膀胱容量增加到对照容量的约 200%。20 至 30Hz 的 PNS 在等容条件下引起大（80-100cmH2O）的膀胱收缩。当与 6 至 10kHz 刺激引起的同侧或双侧阴部神经阻断相结合时，20 至 30Hz 的 PNS 可引起低压（<40cmH2O）高效（70%）排尿。
植入式刺激器产生了所需的刺激波形，并成功地在麻醉猫中诱导了低压高效的排尿。
